HealthCheck December 23, 2011

Publication Announcement

This is the final HealthCheck of the year. Beginning in January 2012, HealthCheck will be published on the final Wednesday of each month.

Legislative and Regulatory Updates

The Department of Health and Human Services (HHS) has released a bulletin outlining the regulatory approach it plans to propose in defining essential health benefits (EHB) under Section 1302 of the Affordable Care Act (ACA). The bulletin solicits public comments on what it describes as a “reference plan based on employer-sponsored coverage in the marketplace today, supplemented as necessary to ensure that plans cover each of the 10 statutory categories of EHB.” Comments are due by Jan. 31, 2012.

HHS also released a final rule addressing the Consumer Operated and Oriented Plan (CO-OP) program. The CO-OP program provides loans to health insurance companies to offer health plans through insurance exchanges. The program seeks to create CO-OP programs in all 50 states and is a key component of the ACA. The final rule establishes CO-OP program eligibility standards, program loan terms, and specifies the standards that organizations must meet to participate in the program. The rule is effective Feb. 11, 2012.

A final rule released by HHS implements the medical loss ratio requirements for health insurance issuers under the ACA. The rules address the treatment of “mini-med” and expatriate policies, modify the way existing regulations treat ICD-10 conversion costs, change the rules on deducting community benefit expenditures, and revise existing regulations governing the distribution of rebates by issuers in group markets. The rule is effective Jan. 3, 2012.

The Joint Select Committee on Deficit Reduction failed to reach a consensus on budget cuts by the Nov. 21, 2011, deadline. This means across-the-board cuts to federal program budgets now will be a possibility, starting in 2013. The cuts will not affect the Medicaid program but there will be a 2 percent spending cut for the Medicare program.

In The News/Media Activities

Rep. Joe Courtney (D-Conn.) in a Nov. 16 MSNBC.com article cited the Academy for a joint Academy and Society of Actuaries January 2010 technical report regarding the excise tax contained in then-proposed health care reform legislation. The actuaries said the proposal, which would use premiums to measure the comprehensiveness of benefits, disproportionately could affect early retirees as well as small business and high-risk professionals—not because their plans are more generous, but because the cost of premiums for these groups tends to be high.

The Academy Risk Sharing Work Group’s Oct. 28 comment letter to the Centers for Medicare & Medicaid Services on the proposed rule for implementing risk-sharing mechanisms included in the ACA was cited in a Dec. 12 report by the Center on Budget and Policy Priorities. The work group wrote that, “Collection by the entity administering the risk-adjustment mechanism provides greater opportunity for audit controls and quality review as well as allowing for other uses of the data in analyzing the effectiveness of the risk-adjustment mechanism and updating the risk-assessment model.”